What is it?
Heartburn occurs when some of the acid normally produced in the stomach for food digestion flows back into the oesophagus (the tube that carries food from the mouth to the stomach). In some cases, this acid may reach the throat, mouth or lungs and cause pain.
Usually, the part of the oesophagus joining the stomach has a ring of muscle that closes off the top of the stomach and keeps the acid from flowing back. But in some people, this mechanism doesn’t work properly and heartburn occurs regularly. This condition is also referred to as gastro-oesophageal reflux disease (GORD) in medical terms.
What are the symptoms?
Because of the way the acid flows, the burning feeling is first felt in the chest and moves upwards to the throat. When the acid gets to the mouth, a sour or bitter taste is felt. Less commonly, bad breath and a dry cough may occur.
When heartburn becomes quite frequent, it can damage the oesophagus and cause more serious problems.
Occasionally, heartburn can be a sign of a more serious condition. So do not hesitate to report to the doctor immediately you notice any of these:
- Black stools or vomitus containing blood.
- Chest pain
- A feeling that food sticks in your throat when you swallow
- Unexplained weight loss
- Easy fatiguability
The doctor will probably perform some investigations just to be sure these symptoms are not caused by anything sinister.
What treatments work?
There are a number of effective drugs to help with heartburn. However, there are some lifestyle modifications that could probably work. They include: stopping smoking, healthy weight reduction, avoiding eating late at night, and reducing alcohol and caffeine intake. Raising the head of the bed at night may help to keep the acid in the stomach.
Over-the-counter medicines called antacids may be the only treatment needed if heartburn occurs infrequently. They reduce the irritation from stomach acid, and some types form a barrier to stop acid splashing up into the oesophagus. The doctor or pharmacist will guide you advice about how to take your medicines.
If heartburn occurs frequently, the doctor may prescribe a type of drug called a proton pump inhibitor. They work by reducing the amount of acid in the stomach, and can also repair the damage to the oesophagus. Some examples include omeprazole, lansoprazole and esomeprazole.
If you can’t take a proton pump inhibitor (for example, if you get side effects), the doctor may prescribe a medicine called an H2 blocker. H2 blockers reduce the amount of acid in your stomach, but not as effectively as proton pump inhibitors. It may be taken in addition to a PPI if the PPI doesn’t stop you from getting heartburn at night. Some examples of H2 blockers are cimetidine, famotidine and ranitidine.
People who do not wish to take drugs for a long time may opt for a surgery called fundoplication. This operation involves strengthening the ring of muscle in the oesophagus that closes off the top of the stomach, hence preventing backflow of acid.